Repository logo
 
Publication

Optimizing Risk Stratification in Heart Failure and the Selection of Candidates for Heart Transplantation

2018-02Journal article Open access
Simple item page
dc.contributor.authorPereira-da-Silva, T
dc.contributor.authorSoares, RM
dc.contributor.authorPapoila, AL
dc.contributor.authorPinto, I
dc.contributor.authorFeliciano, J
dc.contributor.authorAlmeida-Morais, L
dc.contributor.authorAbreu, A
dc.contributor.authorCruz Ferreira, R
dc.date.accessioned2018-11-29T13:00:30Z
dc.date.available2018-11-29T13:00:30Z
dc.date.issued2018-02
dc.description.abstractINTRODUCTION AND AIMS: Selecting patients for heart transplantation is challenging. We aimed to identify the most important risk predictors in heart failure and an approach to optimize the selection of candidates for heart transplantation. METHODS: Ambulatory patients followed in our center with symptomatic heart failure and left ventricular ejection fraction ≤40% prospectively underwent a comprehensive baseline assessment including clinical, laboratory, electrocardiographic, echocardiographic, and cardiopulmonary exercise testing parameters. All patients were followed for 60 months. The combined endpoint was cardiac death, urgent heart transplantation or need for mechanical circulatory support, up to 36 months. RESULTS: In the 263 enrolled patients (75% male, age 54±12 years), 54 events occurred. The independent predictors of adverse outcome were ventilatory efficiency (VE/VCO2) slope (HR 1.14, 95% CI 1.11-1.18), creatinine level (HR 2.23, 95% CI 1.14-4.36), and left ventricular ejection fraction (HR 0.96, 95% CI 0.93-0.99). VE/VCO2 slope was the most accurate risk predictor at any follow-up time analyzed (up to 60 months). The threshold of 39.0 yielded high specificity (97%), discriminated a worse or better prognosis than that reported for post-heart transplantation, and outperformed peak oxygen consumption thresholds of 10.0 or 12.0 ml/kg/min. For low-risk patients (VE/VCO2 slope <39.0), sodium and creatinine levels and variations in end-tidal carbon dioxide partial pressure on exercise identified those with excellent prognosis. CONCLUSIONS: VE/VCO2 slope was the most accurate parameter for risk stratification in patients with heart failure and reduced ejection fraction. Those with VE/VCO2 slope ≥39.0 may benefit from heart transplantation.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationRev Port Cardiol. 2018 Feb;37(2):129-137.pt_PT
dc.identifier.doi10.1016/j.repc.2017.06.018pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3106
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSociedade Portuguesa de Cardiologiapt_PT
dc.subjectHSM CARpt_PT
dc.subjectHeart Failure/physiopathologypt_PT
dc.subjectHeart Failure/surgerypt_PT
dc.subjectHeart Function Testspt_PT
dc.subjectHeart Transplantationpt_PT
dc.subjectPatient Selectionpt_PT
dc.subjectProspective Studiespt_PT
dc.subjectRisk Assessment
dc.titleOptimizing Risk Stratification in Heart Failure and the Selection of Candidates for Heart Transplantationpt_PT
dc.title.alternativeAprimoramento da Estratificação de Risco na Insuficiência Cardíaca e da Seleção de Candidatos a Transplantação Cardíacapt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage137pt_PT
oaire.citation.issue2pt_PT
oaire.citation.startPage129pt_PT
oaire.citation.titleRevista Portuguesa de Cardiologiapt_PT
oaire.citation.volume37pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

Files

Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
RPC 2018 129.pdf
Size:
756.16 KB
Format:
Adobe Portable Document Format
Download
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
1.71 KB
Format:
Item-specific license agreed upon to submission
Description:
Download

Collections

CAR - Artigos